肿瘤医院呼吸机相关性肺炎的真菌感染特点分析

目的:探讨肿瘤医院呼吸机相关真菌性肺炎(VAP-F)发生的临床与病原菌特点,为临床提供指导.方法:选取中山大学肿瘤防治中心2006-01-2009-09 ICU住院并行机械通气时间>48 h,ICU收治时间>7 d,且于ICU治疗期间始终未出现中性粒细胞缺乏、免疫抑制的肿瘤患者,排除输入性真菌感染或已行预防性抗真菌治疗者,其中拟诊真菌感染者为VAP-F组,其余设为对照组.结果:按标准共收集病历44例,VAP-F组20例,对照组24例,VAP-F发生率为45.45%(20/44).最常见菌为白色念殊菌12例(60.0%),近平滑念珠菌4例(20.0%),光滑念珠菌3例(15.0%).热带念珠菌1例(5.0%).所合并细菌以革兰阳性菌(64.7%)为主.两组间呼吸机通气时间、年龄及是否合并细菌感染差异有统计学意义(P<0.05),而患者体质量、是否行胃肠道手术、术前术后肺功能氧合指数(OI)及其变化等指标两组间差异无统计学意义.Logistic回归分析表明,是否合并细菌感染是吸机相关真菌性肺的独立危险因素.结论:肿瘤患者VAP-F的发生与是否合并细菌感染有关,若临床已行针对细菌治疗,建议同时行预防性抗真菌治疗.

Analysis of characteristics about ventilator-associated pneumonia caused by fungi in cancer hospital

OBJECTIVE:To analyze the clinical and pathogenic characteristics of ventilator-associated pneumonia caused by fungi (VAP-F) in the ICU of Sun Yat-sen University Cancer Center.METHODS:The cancer patients ventilated mechanicaly over 48 hours and stayed at least 7 days in the ICU of our Cancer Center from January 2006 to September 2009 were included in the study.The VAP-F group was composed of the cases in accord with the diagnosis of probable fungal infection,while the rest VAP patients without fungal infecti...